Central Texas Workforce Center

Two Parent Family Work Requirement Form

Families that receive TANF (Temporary Assistance for Needy Families) benefits are required to participate in Choices activities. Choices activities help you find and keep a job to support your family.

Two Mandatory Adults
In your family ______and ______are required to participate a combined total of______average hours per week in Choices activities (example: Job Search, Employment, etc.)
If this work requirement is not met by the family (one or both adults), BOTH adults will receive a reduction in their TANF benefits.
______has agreed to participate ______hours per week.
______has agreed to participate ______hours per week.
My signature confirms that I understand my family's work requirements:
Name (please print)______/ SSN______
Signature______/ Date______
Name (please print)______/ SSN______
Signature______/ Date______
One Mandatory and One Exempt Adult
In your family ______is required to participate a total of______average hours per week in Choices activities (example: Job Search, Employment, etc.)
If the adult required to participate does not meet this work requirement, their portion of the family's TANF benefits will be reduced.
______has agreed to participate ______hours per week.
My signature confirms that I understand my family's work requirements:
Name (please print)______/ SSN______
Signature______/ Date______
One Mandatory and One Exempt Adult that Volunteers
In your family ______is required to participate and ______has volunteered to participate a combined total of______average hours per week in Choices activities (example: Job Search, Employment, etc.)
If this work requirement is not met by the family (one or both adults), the mandatory adult's portion of the family's TANF benefits will be reduced.
______has agreed to participate ______hours per week.
______has agreed to participate ______hours per week.
My signature confirms that I understand my family's work requirements:
Name (please print)______/ SSN______
Signature______/ Date______
Name (please print)______/ SSN______
Signature______/ Date______

E-120 (0901) WD Letter 35-01, Attachment 2

Family Work Requirement Form

PURPOSE

  • To notify the two-parent family of their work requirement.
  • To document the individual responsibility of each adult in achieving the family work requirement.
  • To notify the two-parent family of the penalty that will be initiated on one or both adults if the family work requirement is not met.

PROCEDURE

When to Prepare

  • This form must be completed after the Family Employment Plan has been finalized.

Number of Copies

  • Workforce Center staff complete an original and one or two copies (as appropriate).

Transmittal

  • Two Mandatory Adults: Workforce Center staff gives 1 copy to the family and retains the original.
  • One Mandatory and One Exempt Adult: Workforce Center staff gives 1 copy to the mandatory adult and one copy to the exempt adult (in person or by mail) and retains the original.
  • One Mandatory and One Exempt Adult that Volunteers: Workforce Center staff gives 1 copy to the family and retains the original.

Form Retention

  • Workforce Center staff retains the form for three years from the date of case closure.

DETAILED INSTRUCTIONS

Workforce Center staff select the correct section to use and "X" the unused sections. For example, if both adults in the two-parent family are mandatory you would use the section entitled "Two Mandatory Adults" and "X" out the two unused sections.

Two Mandatory Adults

  1. Insert the names of both mandatory adults and the combined total of hours per week that they are required to participate.
  2. Insert the names of both mandatory adults and individually list the hours they will participate per week.
  3. Name- self explanatory

SSN- self explanatory

Signature- self explanatory

Date- date form was signed

One Mandatory and One Exempt Adult

  1. Insert the name of the mandatory adult and the total of hours per week that he/she is required to participate.
  2. Insert the name of the mandatory adult and the hours that he/she will participate per week.
  3. Name- self explanatory

SSN- self explanatory

Signature- self explanatory

Date- date form was signed

One Mandatory and One Exempt Adult that Volunteers

  1. Insert the names of the mandatory adult and the exempt adult who has volunteered to participate. Insert the combined total of hours per week that the family is required to participate.
  2. Insert the names of both adults and individually list the hours they will participate per week.
  3. Name- self explanatory

SSN- self explanatory

Signature- self explanatory

Date- date form was signed

E-120 (0901) WD Letter 35-01, Attachment 2